Valuing and Educating Advanced Practice Nurses (APRNs): Things You Must Know

1. Valuing and Educating Advanced Practice Nurses (APRNs): Things You Must Know 5th Annual Nursing Leadership and Educational Seminar Philippine Nurse Association of Texas- Cameron Co, Inc. December 2, 2011

2. Emergence of APRNs • Defined: application of an expanded range of practical, theoretical and research-based competencies to phenomena experienced by patients within a specialized area (Hamric, et al, 2005, pg. 89. • Term, advanced practice, 4 major roles • Certified registered nurse anesthetist (evolved from civil war experiences) • Certified Nurse Midwife (initial, can be a non nurse) • Clinical nurse specialist (1950’s, roots in psych nursing) • Nurse Practitioner (1960’s, evolved from shortage of primary care providers0

3. Nurse Midwifery • 2008, 45 accredited programs in US (41, MSN) • 2008, two programs for non nurses • 1900s, development of these programs • Early 20th century, medical care no better than midwifery care • 1910,Reform in MD education, Flexner Report, Carnegie Foundation • 1912, J. Whitridge Williams, professor of OB at Johns Hopkins, obstetricians as harmful as midwifery care, if not more so (more deaths in hands of OB,MDs, than in hands of midwives

4. Certified Registered Nurse Anesthetists (CRNAs) • 1846, anesthesia in the US, William T. Morton, Massachusetts General Hospital • 1877, Sister Mary Barnard, first recorded nurse anesthetist • Succeeding years, nuns performed as nurse anesthetists • 1912, Mother Superior Magdalene Wiedlocher, developed course for sisters who were graduate nurses

5. CRNAs • 1889, St Mary’s Hospital, later the Mayo Clinic, relied on nurse anesthetists by choice • First anesthetists at Mayo Clinic: Dinah and Edith Graham • Mayo Clinic model for nurse anesthetist education became global model • Nurse anesthetist movement resisted by organized nursing, formed their own organization • 1970’s, Rush University in Chicago, MSN, major breakthrough

6. Clinical Nurse Specialist (CNS) • Before WWII, advanced in nursing education & nursing administration • 1944, NLNE Committee, study on post-graduate education, genesis • Barriers: post WWII, increased need for generalists, veteran nurses eligible for GI Bill • Shift from private duty to supervisory model • National Mental Health Act: psychiatric nursing recognized as core discipline • Peplau: developed first master’s program, advanced practice in psychiatric nursing

7. CNSs • 1963, Professional Nurse Traineeship Program, major force in CNS movement • 1970s, variety of master’s level programs for various practice settings • 1980, ANA’s social policy statement to clarify role for resolution of role confusion • Role grew out of needs recognized of nurse educators and clinicians • Funding for advanced nursing: RWJ, NIMH, Bureau of Health Professions, Division of Nursing, HRSA, private foundations

8. Nurse Practitioners (NPs) • Development in response to opportunistic environment • Aims: prepare graduate students for clinical specializations & to reclaim the role historically held by public health nurses • 1965: demonstration project at University of Colorado tested scope of practice; distribution problem of MDs in geographic areas provided opportunity to test expanded role (funding denied by Children’s bureau)

9. NPs • Federal support held back for political reasons • BPHr funded the Colorado project • 1977, 84 master’s programs and 133 certificate programs (supported by the Department of Health Education and Welfare) • 2008, 323 master’s programs with one or more specialty areas

10. Advanced Practice • Function at a more specialized level than the registered nurse • Considered complex • Application of greater breadth of knowledge & complexity of decision making • Require high levels of critical thinking and autonomy

11. Critical Events • NP role led educators to reject the role and close access to university education • Education evolved outside of traditional nursing programs • More of a doctor-nurse partnership • 1960’s and 1970’s: women’s movement led to autonomy from other providers, MDs • 1980’s & 1990’s: NP role viewed as potential cost effective option to growing health care need for services • NP education then housed in Universities • CNS role blurred, too costly for hospitals

12. Critical Events • Legislative reforms decreased barriers to autonomous practice • Health care reform, change in landscape

13. The University of Texas BrownsvilleMaster of Science in Nursing • Nursing Education • Nursing Administration • Nursing Administration/clinical • Apply to Graduate Studies (Mari Montelongo 956 882 7787, mari.montelongo@utb.edu ) • Apply to College of Nursing, Graduate Nursing Education (Monica Ramos 956 882 5102, monica.ramos@utb.edu )

14. UTB, MSN • Prerequisites • Introductory statistics • GPA 3.0 • Licensed to practice in Texas • CBC • Release • Forms from Monica • Immunizations • List from Monica